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<html style="overflow-x:auto;overflow-y:auto;" xmlns:th="http://www.thymeleaf.org"><head><meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
	<title>社保缴费管理 - Powered By JeeSite</title>
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</head>
<body>
	
	<ul class="nav nav-tabs">
		<li><a href="../shebaoRecordList/saved_resource.html">社保缴费列表</a></li>
		<li class="active"><a href="saved_resource.html">社保缴费修改</a></li>
	</ul><br>
	<form id="inputForm" class="form-horizontal" action="#" method="post" novalidate="novalidate">
		<input id="id" name="id" type="hidden" value="2">
		














<script type="text/javascript">top.$.jBox.closeTip();</script>
	
		<table class="table table-bordered table-condensed">
			<tbody><tr>
				<td><label class="control-label">客户名称：</label></td>
				<td>
					<input type="text" id="customer_name" name="customerName" value="" onblur="getCustomerByName();" style="width:270px;">
				</td>
				<td><label class="control-label">身份证号：</label></td>
				<td><input type="text" name="idcard" htmlescape="false" maxlength="20" class="input-xlarge " style="width:270px;">
					<span class="help-inline"><font color="red">*</font> </span>
				</td>
			</tr>
		
			<tr>
				<td><label class="control-label">社保号码：</label></td>
				<td>
					<input id="sdcard" name="sdcard" class="input-xlarge required" type="text" value="1000047" maxlength="20">
					<span class="help-inline"><font color="red">*</font> </span>
				</td>
				<td>
					<label class="control-label">所属公司：</label>
				</td><td>
					<select path="companyid" class="input-xlarge ">
					<option value="" label="">
					
					</option></select>
				</td>
				
			</tr>
			<tr>
				<td><label class="control-label">手机号码：</label></td>
				<td><input type="text" name="phone" htmlescape="true" maxlength="13" style="width:270px;"></td>
				<td><label class="control-label">现在住址：</label></td>
				<td><input type="text" name="address" htmlescape="true" maxlength="100" style="width:270px;"></td>
			</tr>
			<tr>
				<td><label class="control-label">养老保险：</label></td>
				<td><input id="yanglao" name="yanglao" class="input-xlarge " type="text" value="200"></td>
				<td><label class="control-label">医疗保险：</label></td>
				<td><input id="yiliao" name="yiliao" class="input-xlarge " type="text" value="200"></td>
			</tr>
			<tr>
				
				<td><label class="control-label">工伤保险：</label></td>
				<td><input id="gongshang" name="gongshang" class="input-xlarge " type="text" value="200"></td>
				<td><label class="control-label">失业保险：</label></td>
				<td><input id="shiye" name="shiye" class="input-xlarge " type="text" value="100"></td>
			</tr>
			
			<tr>
				<td><label class="control-label">生育保险：</label></td>
				<td><input id="shengyu" name="shengyu" class="input-xlarge " type="text" value="70"></td>
				<td><label class="control-label">缴费金额：</label></td>
				<td>
					<input id="paymoney" name="paymoney" class="input-xlarge " type="text" value="870">
				</td>
			</tr>
			
			<tr>
				<td><label class="control-label">缴费期间：</label></td>
				<td>
					<input id="paymonth" name="paymonth" class="input-xlarge " type="text" value="2017年09月" maxlength="20">
					<span class="help-inline"><font color="red">*</font> </span>
				</td>
				<td><label class="control-label">缴费状态：</label></td>
				<td>
					<select name="status"  class="select2-offscreen">
						<option value="1">未交</option>
						<option value="0">已交</option>
					</select>
					<span class="help-inline"><font color="red">*</font> </span>
				</td>
			</tr>
			
			<tr>
				<td><label class="control-label">备注信息：</label></td>
				<td colspan="3">
					<input id="remark" name="remark" class="input-xlarge " type="text" value="test">
				</td>
			</tr>
		</tbody></table>		
		<div class="form-actions">
			<input id="btnSubmit" class="btn btn-primary" type="submit" value="保 存">&nbsp;
			<input id="btnCancel" class="btn" type="button" value="返 回" onclick="history.go(-1)">
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	</form>

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